Treatment of colitis by oral negatively charged nanostructured curcumin in rats

PURPOSE

To examine the effects of a negatively charged nanostructured curcumin microemulsion in experimental ulcerative colitis (UC) in rats.

METHODS

Four percent acetic acid was used to induce UC. The animals were treated for seven days and randomly assigned to four groups: normal control (NC), colitis/normal saline (COL/NS), colitis/curcumin (COL/CUR), and colitis/mesalazine (COL/MES). The nanostructured curcumin was formulated with a negative zeta potential (-16.70 ± 1.66 mV). Dosage of the pro-inflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin 1-β (IL-1β), interleukin 6 (IL-6), and antioxidant enzymes (catalase, superoxide dismutase, and glutathione peroxidase), macro and microscopic evaluation of the colon tissue were analyzed.

RESULTS

The COL/CUR group had a higher level of antioxidant enzymes compared to the COL/MESgroup. The levels of TNF-α, IL-1β and IL-6 were significantly lower in the colonic tissue of the COL/CUR group rats, when compared to the COL/NS and COL/MES groups (p < 0.001). The presence of ulcers in the colonic mucosa in rats of the COL/NSgroup was significantly higher than in the COL/MES group (p < 0.001). In the NC and COL/CUR groups, there were no ulcers in the colonic mucosa.

CONCLUSIONS

The nanostructured microemulsion of curcumin, used orally, positively influenced the results of the treatment of UC in rats. The data also suggests that nanostructured curcumin with negative zeta potential is a promising phytopharmaceutical oral delivery system for UC therapy. Further research needs to be done to better understand the mechanisms of the negatively charged nanostructured curcumin microemulsion in UC therapy.

Nanostructured systems increase the in vitro cytotoxic effect of bullfrog oil in human melanoma cells (A2058)

The aim of this work was to investigate the in vitro cytotoxic effect of previously developed nanocapsules, nanoemulsion, and microemulsion based on bullfrog oil (BFO) against human melanoma cells (A2058). The nanosystems were produced as described in previous studies and characterized according to droplet/particle distribution and zeta potential. The biocompatibility was evaluated by the determination of the hemolytic potential against human erythrocytes. The cytotoxicity assessment was based on MTT and cell death assays, determination of Reactive Oxygen Species (ROS) levels, and cell uptake. The nanosystems were successfully reproduced and showed hemolytic potential smaller than 10% at all oil concentrations (50 and 100 µg.mL^-1) (p < 0.05). The MTT assay revealed that the nanosystems decreased the mitochondrial activity up to 92 ± 2% (p < 0.05). The study showed that the free BFO induced cell apoptosis, while all the nanostructured systems caused cell death by necrosis associated with a ROS overproduction. This can be related to the increased ability of the nanostructured systems to deliver the BFO across all cellular compartments (membrane, cytoplasm, and nucleus). Finally, these results elucidate the in vitro BFO nanosystems cytotoxic effect against human melanoma cells (A2058), revealing the emulsified ones as the most cytotoxic systems. Overall, the findings suggest that the safety and antineoplastic activity of these systems can be further investigated by in vivo studies.

Anti-Inflammatory Activity of Bullfrog Oil Polymeric Nanocapsules: From the Design to Preclinical Trials

BACKGROUND

Although bullfrog oil (BFO) exerts anti-inflammatory effects, it has undesirable properties limiting its use.

METHODOLOGY

BFO nanocapsules (BFONc) were produced through nanoprecipitation, and their physicochemical and morphological properties were characterized. To evaluate the biocompatibility of the formulation, a mitochondrial activity evaluation assay was conducted, and cell uptake was assessed. The in vitro anti-inflammatory activity was evaluated by measuring reactive oxygen species (ROS), nitric oxide (NO), type-6 interleukin (IL-6), and tumor necrosis factor (TNF) levels. The in vivo anti-inflammatory effect was assessed by quantifying myeloperoxidase (MPO) levels using the carrageenan-induced paw edema model.

RESULTS

BFONc showed a particle size of 233 ± 22 nm, a polydispersity index of 0.17 ± 0.03, and a zeta potential of -34 ± 2.6mV. BFONc revealed remarkable biocompatibility and did not induce changes in cell morphology. Furthermore, BFONc decreased ROS levels by 81 ± 4%; however, NO level increased by 72 ± 18%. TNF and IL-6 levels were reduced by approximately 10% and 90%, respectively. Significant in vivo anti-inflammatory activity was observed compared to dexamethasone. MPO levels were reduced up to 2 MPOs/mg.

CONCLUSION

Taken together, the results pointed out the remarkable biocompatibility and anti-inflammatory effects of BFONc.

Effect of the Ileum and Colon on Liver Regeneration

PURPOSE

The colon and ileum play significant roles on liver physiology. Studies about simultaneous hepatectomy and colectomy or enterectomy are scarce and controversial. We investigated and compared the effects of ileum and colon resection on liver regeneration.

MATERIALS AND METHODS

Twenty four Wistar rats were allocated in group I-(sham), group II-70% hepatectomy; group III-70% hepatectomy + ileal resection, and group IV-70% hepatectomy + partial colectomy. On the sixth day, serum hepatic enzymes, albumin, hepatocyte growth-factor (HGF) and transforming growth factor-alpha (TGF-α) were measured. The hepatic regeneration rate was estimated. Ki-67 immunohistochemical analysis was done in remnant liver.

RESULTS

Hepatic enzymes levels were significantly higher in group III rats comparing to the other groups (p < 0.001). In group IV, the levels were significantly lower than in groups II and III (p < 0.001). Albuminemia was significantly lower in group III rats comparing with the other groups (p < 0.001). Albuminemia was not different comparing groups I and IV (p > 0.05). Cytokines HGF and TGF-α levels in group IV were significantly higher than in the other groups (p < 0.001). Liver regeneration rate was higher group IV than in groups II and III, and the difference was statistically significant (p = 0.002). The hepatocytes expression of Ki-67 was significantly higher in the remnant liver of group IV than in group III (p = 0.002). There was no difference in Ki-67 expression between groups II and IV (p > 0.05).

CONCLUSION

Ileum and colon resection have different effects on liver regeneration. Colon resection positively influences liver regeneration, while ileum resection negatively influences the regenerative process, in a rat model.

Transcranial direct current stimulation on the autonomic modulation and exercise time in individuals with spinal cord injury. A case report

PURPOSE

To report the effect of the transcranial direct current stimulation (tDCS) applied over the primary motor cortex (M1) of an individual, a sedentary male subject with complete chronic spinal cord injury at the T11-T12 levels.

METHODS

The individual underwent three experimental sessions: control, sham and anodal tDCS. Before, during and after exercise sessions, the following variables were recorded: heart rate variability, Rating of Perceived Exertion (RPE), power and glucose (this one only before and after the exercise).

RESULTS

The anodal tDCS provided greater exercise time and power, lower perceived exertion, greater reduction in glucose, and an increase in time to reach the threshold of heart rate variability.

CONCLUSIONS

tDCS caused an improvement in the exercise tolerance, probably due to the modulation of the autonomic nervous system and the pain, characterized by reduced RPE.

[Effect of the simvastatin in abdominal sepsis of diabetic rats]

OBJECTIVE

Infection and sepsis are major causes of morbidity and mortality after surgery of diabetic patients. Statins have been shown to exhibit anti-inflammatory and immunomodulatory (pleiotropic) effects, independent of lipid lowering. This study aimed to observe whether the pretreatment with simvastatin in a cecal ligation and perforation model of sepsis is beneficial in diabetic rats.

METHODS

Fifty six Wistar rats were randomly assigned to non-diabetic group (n=28), and streptozotocin-induced diabetic group (n=28). Abdominal sepsis was induced in 14 diabetic and in 14 non diabetic rats and the other 28 rats were allocated on sham group. Sepsis rats and sham rats (each with 7 animals) were treated with oral simvastatin (20 mg kg-1 day-1) or normal saline solution 0.9%. Peripheral blood TNFalpha, IL-1beta, IL-6, C-reactive protein, procalcitonin, leukocytes and neutrophils were tested in all the animals. Statistical analysis was done by ANOVA and Tukey test, with p<0.05.

RESULTS

Simvastatin reduced mortality in diabetic rats. Peripheral blood TNFalpha, IL-1beta, IL-6, C-reactive protein, procalcitonin, leukocytes and neutrophils were lower in diabetic and non diabetics septic rats treated with simvastatin, than after saline treatment.

CONCLUSION

Simvastatin showed anti-inflammatory effect, which could play some protection against the progress of sepsis in diabetic rats.

Xylan from corn cobs, a promising polymer for drug delivery: production and characterization

Although many authors have reported several beneficial effects ascribed to xylan, such as inhibitory action on mutagenicity activity, antiphlogistic effects, and mitogenic and comitogenic activities, few papers have investigated a systematic study on the technological properties of this polymer. The aim of the present work was to evaluate xylan as a promise raw material for the pharmaceutical industry. The water-insoluble xylan samples were extracted from corn cobs following several steps. The obtained powered sample was analyzed by infrared and RMN spectroscopy, and characterized regarding their particle size, bulk and tap densities, compressibility index, compactability, Hausner ratio, and angle of repose. According to the results, infrared and RMN spectroscopy were shown to be able to evaluate the xylan structural conformation and composition, respectively. In addition, rheological data demonstrated that xylan powder obtained from corn cobs may be characterized as a material with low density and very cohesive flow properties.

Effect of cationic micelles on the decomposition of alpha-aminophenyl cephalosporins

The intramolecular rates of degradation of alpha-aminophenyl cephalosporins were determined with and without hexadecyltrimethylammonium bromide (CTAB). Micellar-derived spectral shifts were used to measure the bind of the ionic forms as well as to determine the effect of CTAB on the apparent dissociation constant of the antibiotics. The rate of the degradation of cephalexin (Cp), cefadroxil (Cf), and cephradine (Cph), increased with surfactant concentration reaching a plateau at high surfactant concentrations. In the plateau region, the rate constant was salt sensitive decreasing with NaBr concentrations. These effects were quantitatively analyzed within the framework of the pseudo-phase model with explicit considerations of ion exchange. All the experimental results were fitted to this model. The intramolecular degradation of Cf, Cp and Cph was catalyzed by 96-, 59-, and 29-fold, respectively. A working hypothesis to rationalize these effects was suggested. The obtained results demonstrate that the quantitative analysis can be used to assess, predict and control the effects of surfactants on the drug stability.

Glucan and Glutamine Reduce Bacterial Translocation in Rats Subjected to Intestinal Ischemia–Reperfusion

Intestinal ischemia/reperfusion (I/R) may induce bacterial translocation (BT). Glutamine (GLN)-enriched nutrition decreases BT. However, little is known about the effect of glucan (GL) in BT. This study investigated the combined effect of GL/GLN on BT, intestinal damage, and portal blood cytokines in animals under I/R. Four groups of 10 rats each were subjected to 60 min of intestinal ischemia and 120 min of reperfusion. The control group (group 1) received only rat food/water, group 2 received glutamine via gavage, group 3 received subcutaneuos soluble (1, 3)-d-glucan, and group 4 received GL + GLN. A sham group (group 5) served as a normal control. Bacterial cultures of ileum, mesenteric lymph nodes (MLN), liver and lung biopsies, histological changes of ileum, and serum cytokines variables were examined after I/R. Data were analyzed by analysis of variance (ANOVA) and the Newman-Keuls test. Results showed that GLN, GL, and GL/GLN significantly reduced BT to MLN, liver, and lung. BT was more attenuated after GL treatment than GLN (P < .05). Rats treated with both GL and GLN exhibited lower bacterial colony counts than the ones treated only with GLN or GL. Severe mucosal damage on histological findings was shown in group 1, but these findings were significantly ameliorated (P < .05) in groups 3 and 4. Tumor necrosis factor (TNF)-a and interleukin (IL)-6 levels in portal serum were significantly reduced and IL-10 was increased by GL and GLN treatment. In conclusion, the use of GL was more effective than GLN in reducing BT, intestinal damage, and cytokine levels after I/R. Additionally, the combination of GL and GLN improved results.

Stationary cuvette: a new approach to obtaining analytical curves by UV-VIS spectrophotometry

BACKGROUND

Investigations in the field of pharmaceutical analysis and quality control of medicines require analytical procedures that achieve suitable performance. An analytical curve is one of the most important steps in the chemical analysis presenting a direct relationship to features such as linearity.

OBJECTIVE

This study has the aim of developing a new methodology, the stationary cuvette, to derive analytical curves by spectroscopy for drug analysis.

METHODOLOGY

The method consists basically of the use of a cuvette with a path length of 10 cm, containing a constant volume of solvent in which increasing amounts of a stock solution of the sample are added, droplet by droplet. After each addition, the cuvette is stirred and the absorbance is measured. This procedure was compared with the currently used methodology, which requires a labour-intensive dilution process, and possible sources of variation between them were evaluated.

RESULTS

The results demonstrated that the proposed technique presented high sensitivity and similar reproducibility compared with the conventional methodology. In addition, a number of advantages were observed, such as user-friendliness, cost-effectiveness, accuracy, precision and robustness.

CONCLUSION

The stationary cuvette approach may be considered to be an appropriate alternative to derive analytical curves for analysing drug content in raw materials and medicines through UV-VIS spectrophotometry.

[Abortion in adolescence: who committed it in Maceió, Alagoas, Brazil]

This quantitative and cross study aims at establishing a profile of female teenagers, from 12 to 19 years old, that committed abortion in a representative random sample of 2592 adolescents in Maceió, Alagoas, Brazil, in 2005. There were found 149 abortions, where most of them (81.9%) did not have a job, (85%) lived with the parents, (85.2%) were single, (69.8%) studied in a public school and (70.5%) were in high school. The majority had one abortion 93%, but it stands out that 8.5% of them aborted twice and 2.6% four times, showing this data the inadequate attention to teenagers reproductive health. In order to have an abortion, 63.8% of them had support, 83.9% did not have physical complications and 89.3% did not need hospitalization. The conclusion is that the teenagers are getting pregnant and still attending school, looking for abortion as a solution for a not planned pregnancy and that the lack of need of hospitalization post abortion contributes to the statics lack.

Oil-in-water lecithin-based microemulsions as a potential delivery system for amphotericin B

In this work the structural features of microemulsions (MEs) containing the pharmaceutical biocompatible Soya phosphatidylcholine/Tween 20 (1:1) as surfactant (S), Captex 200 as oil phase (O), and phosphate buffer 10mM, pH 7.2 as aqueous phase (W) were studied. Systems obtained with different proportions of the components were described by pseudo-ternary phase diagrams in order to characterize the microemulsions studied here. MEs were prepared with and without the polyene antifungal drug amphotericin B (AmB). The maximum AmB incorporation into the ME system was dependent on both the oil phase and surfactant proportions with 6.80 and 5.7 mg/mL in high contents, respectively. The incorporation of AmB into the ME systems significantly increased the profile of the droplet size of the ME for all ranges of surfactant proportions used in the formulations. The microstructures of the system were characterized by dynamic light scattering (DLS) and rheological behavior. The DLS results showed that the size of the oil droplets increases 4.6-fold when AmB is incorporated into the ME system. In all cases the increase in the proportion of the oil phase of the ME leads to a slight increase in the diameter of the oil droplets of the system. Furthermore, for both the AmB-loaded and AmB-unloaded MEs, the size of the oil droplets decrease significantly with the increase of the S proportion in the formulations, demonstrating the efficiency of the surfactant in stabilizing the ME. Depending on the ME composition, an anti-thixotropic behavior was found. The maximum increases of the consistency index caused by the increase of the oil phase of the ME were of 17- and 25-times for the drug-loaded and drug-unloaded MEs, respectively. However, the observed effect for the drug-loaded ME was about 4.6 times higher than that for the drug-unloaded one, demonstrating the strong effect of the drug on the rheological characteristics of the ME system. Therefore, it is possible to conclude that the investigated ME can be used as a very promising vehicle for AmB.

Structural changes of biocompatible neutral microemulsions stabilized by mixed surfactant containing soya phosphatidylcholine and their relationship with doxorubicin release

Depending on the composition, the mixture of surfactant, oil and water, may form supramolecular aggregates with different structures which can significantly influence the drug release. In this work several microemulsion (ME) systems containing soya phosphatidylcholine (SPC) and eumulgin HRE40 (EU) as surfactant, cholesterol (O) as oil phase, and ultra-pure water as an aqueous phase were studied. MEs with and without the antitumoral drug doxorubicin (DOX) were prepared. The microstructures of the systems were characterized by photon correlation spectroscopy, rheological behavior, polarized light microscopy, small-angle X-ray scattering (SAXS) and X-ray diffraction (XRD). The results reveal that the diameter of the oil droplets was dependent on the surfactant (S) amount added to formulations. The apparent viscosity was dependent on the O/S ratio. High O/S ratio leads to the crystallization of cholesterol polymorphs phases which restricts the mobility of the DOX molecules into the ME structure. Droplets with short-range spatial correlation were formed from the ME with the low O/S ratio. The increase of the cholesterol fraction in the O/S mixture leads to the formation of ordered structures with lamellar arrangements. These different structural organizations directly influenced the drug release profiles. The in vitro release assay showed that the increase of the O/S ratio in the formulations inhibited the constant rate of DOX release. Since the DOX release ratio was directly dependent on the ratio of O/S following an exponential decay profile, this feature can be used to control the DOX release from the ME formulations.

SolEmuls technology: a way to overcome the drawback of parenteral administration of insoluble drugs

In this article, a nanosuspension of AmB was prepared and mixed with the preformed parenteral emulsion Lipofundin and subjected to high-pressure homogenization (SolEmuls technology). Characterization was performed by photon correlation spectroscopy (PCS), laser diffractometry (LD), and zeta potential measurements. Drug incorporation was studied by using light microscopy. The produced emulsions were further investigated by comparing them with the commercially available Fungizone in regard to antifungal efficiency and toxicity. Results suggest that through the SolEmuls process the AmB forms a reservoir, out of which it is released in such a manner that it is more efficient and less toxic than Fungizone.

Catechol inhibits FADH2-linked respiration in rat liver mitochondrial fraction

PURPOSE

The aim of this work was to investigate the hypothesis that catechol inhibits FADH -linked basal respiration in mitochondria isolated from rat liver homogenates. Moreover, catechol ability to induce peroxidation of biomolecules in liver nuclear fractions was also studied.

METHODS

Rat liver homogenates were incubated with 1mM 1,2-dihydroxybenzene (catechol) at pH 7.4 for up to 30 minutes. After that, mitochondrial fractions were isolated by differential centrifugation. Basal oxygen uptake was measured using a Clark-type electrode after the addition of 10 mM sodium succinate. Nuclear fractions were incubated in the presence of 1 mM catechol for 17 hours at room temperature and the peroxidation of biomolecules was investigated by the reaction with thiobarbituric acid, which was determined spectrophotometrically at 535 nm.

RESULTS

Catechol induced a time-dependent partial inhibition of FADH -linked basal mitochondrial respiration, however this substance was unable to induce a direct peroxidation of biomolecules in hepatic nuclear fractions.

CONCLUSION

Catechol produced an inhibition of basal respiration associated to FADH2 in isolated liver mitochondria that could lead to cytotoxicity, ROS generation and cell death.

Magnetic Carriers: A Promising Device for Targeting Drugs Into the Human Body

Suboptimal disposition behavior of drugs requires innovative delivery approaches. Magnetic drug targeting seems to be a promising one. Magnetic particles develop magnetic polarization and magnetophoretic mobility, and because of such unique properties, these carriers may be eligible candidates for delivering drugs to specific locations within the body. Their special properties also allow other uses, such as those in magnetic separation, hyperthermia, and magnetic resonance imaging. This review focuses on a brief discussion of magnetic drug targeting, the properties and fate of magnetic carriers, the methods used to produce and characterize them, and their other uses in biotechnology.

Simvastatin improves the healing of infected skin wounds of rats

PURPOSE: This study explores the potential of the simvastatin to ameliorate inflammation and infection in open infected skin wounds of rats. METHODS: Fourteen Wistar rats weighing 285±12g were used. The study was done in a group whose open infected skin wounds were treated with topical application of sinvastatina microemulsion (SIM, n=7) and a second group with wounds treated with saline 0.9 % (SAL, n=7). A bacteriological exam of the wounds fluid for gram positive and gram negative bacteria, the tecidual expression of TNFá and IL-1â by imunohistochemical technique, and histological analysis by HE stain were performed. RESULTS: The expression of TNFa could be clearly demonstrated in lower degree in skin wounds treated with simvastatin (668.6 ± 74.7 ìm²) than in saline (2120.0 ± 327.1 ìm²). In comparison, wound tissue from SIM group displayed leukocyte infiltration significantly lower than that observed in SAL group (p<0.05). Culture results of the samples taken from wound fluid on fourth post treatment day revealed wound infection in only one rat of group simvastatin (SIM), where Proteus mirabilis, Escherchia coli and Enterobacter sp were isolated. In the rats whose wounds were treated with saline (SAL), polymicrobial infection with more than 100,000 CFU/g was detected in all the wounds. CONCLUSION: In addition to its antiinflammatory properties, the protective effects of simvastatin in infected open skin wounds is able to reduce infection and probably has antibacterial action. The potential to treat these wounds with statins to ameliorate inflammation and infection is promising.

Effects of simvastatin in abdominal sepsis in rats

PURPOSE: Statins are widely recognized as hypolipemic drugs, but some studies have observed anti-inflammatory and immunomodulatory effects, known as pleiotropic. The aims of this work was to study possible anti-inflammatory effects of simvastatin in abdominal sepsis. Serum pro-inflammatory cytokines and leukocytes count were determined in an experimental model of abdominal sepsis, using cecal ligation and puncture (CLP) in rats. METHODS: Twenty eigth Wistar rats weighing 285±12g were randomly divided in: CLP/Sinvastatin rats (n=7), treated with 10 mg/Kg of oral simvastatin 18 and 2 hs berofe CLP; CLP/Saline group rats (n=7), treated with oral saline; group Sham/Simvastatin (n=7), treated with simvastatin, and group Sham/Saline (n=7), treated with saline. Serum TNF-alpha, IL-1beta and IL-6 by ELISA and total leukocytes, neutrophils, lymphocytes, and eosinophils were determined 24 hs after CLP. ANOVA and Tukey test were used considering significant p<0.05. RESULTS: It was demonstrated that serum TNF-alpha, IL-1beta and IL-6 were respectively 364,8±42pg/mL; 46,3±18pg/mL and 28,4±13pg/mL in CLP/Sinvastatin rats, significantly lower (p<0.05) than in group CLP/Saline (778,5±86pg/ml; 176,9±46pg/ml; 133,6±21 pg/ml, respectively). The same results were observed in total leukocytes and neutrophils counts. CONCLUSION: These results clearly demonstrate that simvastatin is an effective agent that reduces cytokines levels and leukocyte count in sepsis, independently of its well-known lipid-lowering effects. Thus, HMG-CoA reductase inhibitors like simvastatin have important anti-inflammatory effects in abdominal sepsis in rats.

Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage: study in rats

PURPOSE: A comparison was done between the F. Paulino jejunal pouch (FP) and a jejunal pouch (JP) as esophagus-duodenum interpositional graft, for replacing the stomach after total gastrectomy. It was investigated the effect of the two procedures on esophagus histology, nutritional state and serum gastrin in rats. METHODS: Male Wistar rats weighing 282±17g were randomly submitted to sham operation (S), FP and JP after total gastrectomy. After eight weeks the rats were killed with overdose of anesthetic and tissue was taken from the distal esophagus for histology. Serum levels of total proteins, albumin, iron, transferring, folate, cobalamine, calcium, as well as serum gastrin were determined. Survival was considered. RESULTS: Fourty six rats were operated and thirty survived for eight weeks. Five (33.3%) died after FP and 11 (52.3%) after JP (p<0.05). Postoperative esophagitis occurred in 6 JP rats. At 8th week, no difference was observed on body weight when compared FP and JP rats (p>0.05). The JP rats had a significant decrease in serum albumin, glucose, transferrin, iron, folate and calcium, compared to sham (p<0.05). Serum gastrin, iron and calcium were significantly higher in JP rats than in FP rats (p<0.05). In FP rats, transferrin and cobalamine showed significant decrease comparing the preoperative with 8th week levels (p<0.05). CONCLUSION: F. Paulino pouch in rats had lower mortality than JP, and esophagitis was not detected in it. JP rats had serum gastrin, iron and calcium unaffected, possibly because of preservation of duodenal passage.

Treatment of postoperative enterocutaneous fistulas by high-pressure vacuum with a normal oral diet

BACKGROUND/AIMS

Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increased hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem.

METHODS

Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. A normal oral diet was permitted.

RESULTS

No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after 5 days, 16 (22%) after 10 days and 4 (5%) after 15 days. Treatment failed in 6 (8%) patients, who subsequently underwent surgery. The fistula did not close in 1 patient with a low output. The cost of the treatment was USD 41.75/day and it was considered cost-effective.

CONCLUSIONS

The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns.